11 December 2022 - Global

Healthcare Should Not be a Privilege: We need Strong, Integrated Health & Social Protection Systems NOW

by Marionka Pohl, Global Head of Health Policy and Advocacy, Save the Children International and Linda Karungi, Advocacy & Communications Manager, Rwanda & Burundi Country Office

Tomorrow is Universal Health Coverage Day (UHC). Every year advocates around the world gather to hold governments, and other stakeholders to account on their commitments to UHC and progress to achieve health for all children and people worldwide, especially those most impacted by inequality and discrimination.

774 million children in multidimensional poverty – what about their health?

One year ahead of the next gathering by world leaders at a UN high-level meeting on UHC, we are far off from reaching the right to health for all. Ahead of tomorrow’s UHC day, lets state a few facts.

An estimated 100 million people a year are still pushed into poverty due to healthcare costs.
Only 1 in 4 children globally receives some form of social protection benefit.
774 million children live in multidimensional poverty.

The time for strong, integrated health and social protection systems is now. This is why we – in our new policy brief “Strong, integrated health and social protection systems: essential to ensure children’s rights”– look at the interlinkage of universal health coverage and social protection.

Universal Health Care: A Reality with Rwanda's Health Insurance.

Achieving social protection of children and people is closely linked to universal health coverage and vice versa. Health insurance for instance can contribute to the social protection of communities. Look at Rwanda.

Rwanda, with an 84% health insurance coverage rate, is one of the highest in the region and one of only a few countries in Sub-Saharan Africa to meet the health-related Sustainable Development Goals. With steep reductions in both under-fives’ and maternal mortality over the past 15 years, factors that helped Rwanda reach such levels of coverage include:

The prioritization of health, the directing of considerable donor funding into health, and significant investment in health from general taxation.

Importantly however Rwanda’s health insurance scheme covers informal workers, a significant step as a high proportion of its population work in the informal sector.
Contributions to health insurance are very low to make it feasible for people to enter the scheme, to reach the poorest families and most importantly: to ensure children’s rights.

Pauline Ingabire, 42-year-old mother of 6 children, from Bugesera District highly appraises the health insurance scheme in Rwanda:

"Before I enrolled for the insurance, I used bad birth control methods. I had six children one after the other. I did not have time to take care of myself and my children. I almost died during one delivery. Now I deliver my babies at the hospital, not at home. I am also on family planning thanks to the Community Health Workers. And now, I own a small shop. My oldest girl has just completed university and works at a Health Post. That’s my victory!"

“Health insurance is very important for us," says Chantal Murebwayire, whose baby was born prematurely at Muhima Hospital. "I'm no longer afraid to come to be treated or have my children be treated. With the insurance I am sure to have all the care needed. …without paying the bill after such a long hospitalization stay."

Emily with newborn baby Blessing outside their home in Bungoma, Kenya.

The importance of social protection measures to achieve UHC

Vice versa, social protection measures, such as cash transfers, can ensure access to health services, including increased vaccination coverage, antenatal care, skilled attendance at delivery as well as institutional deliveries. In Nigeria, Save the Children’s and Action Against Hunger’s Child Development Grant Programme (CDGP) lead to an uptake of vaccinations, and reduced stunting among the participating children by 5.4 percent.

While it is and will remain imperative for governments to reduce private spendings for health and other essential services, they also need to scale up their support for social protection schemes (including cash transfers and universal child benefits). It’s not enough for countries to have national policies in place for primary care delivery, national governments should be encouraged to take the lead in setting strategies to advance social protection and health coverage and strengthen health care workers, so they are capable (and motivated) to implement them at the national and subnational levels.

Further Action is needed

Yet, to achieve children’s rights, governments and other stakeholders need to do even more. Health and social protection systems need to be both strong AND integrated.

What is key for this? See below a few recommendations to governments from our new policy brief:

Work towards providing health and social protection systems that are integrated. This could be common coordination mechanisms, cross-government working or common registration systems. Health and social protection systems should further be in the best interests of the child.

Increase domestic resources to deliver both universal health coverage as well as universal, child-sensitive and shock-responsive social protection. Tackle financial and non-financial barriers to accessing health and social protection services for children, their families and populations most affected by inequality and discrimination.